Is hematology high yield on the PEBC exam?

Yes, especially the anemias, which are common and very counselling-focused for a pharmacist. VTE prophylaxis and the drugs that affect blood counts also come up. The exact mix is randomized from one sitting to the next, but hematology is consistently worth solid preparation.

What hematology topics should I focus on for the PEBC?

Focus on classifying and working up anemia by cell size, iron-deficiency anemia and oral iron counselling, B12 and folate deficiency, and VTE prophylaxis. Knowing the iron counselling and when to investigate the cause is especially high yield.

Which references should I use for hematology on the PEBC?

Use standard hematology references for the anemias, and Thrombosis Canada for venous thromboembolism prophylaxis and anticoagulation. The PEBC expects the Canadian approach to prophylaxis and the practical counselling for oral iron.

How should I study hematology for the PEBC?

Get comfortable classifying anemia by cell size, learn the oral iron counselling cold, and know the VTE prophylaxis basics.

PEBC Hematology Practice Questions

Hematology is a high-yield area on the PEBC exam, and the anemias are the heart of it. Iron-deficiency anemia, B12 and folate deficiency, and venous thromboembolism prophylaxis all show up, and most questions test classifying the problem and matching the right treatment and counselling.

These free questions are drawn from across those areas. The explanations work through all four options and land on the classification or counselling detail that separates the right call from the tempting one.

Written and reviewed against current Canadian guidelines and references.

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All 4

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How to approach a PEBC hematology question

1For anemia, classify by cell size first: microcytic, normocytic, or macrocytic. The size points you to the cause, such as iron, chronic disease, or B12 and folate.
2For iron-deficiency anemia, know the oral iron counselling (administration, what helps and hurts absorption, GI effects) and when to investigate the underlying cause, such as celiac disease or GI blood loss.
3For B12 and folate deficiency, know the common causes and how to replace each.
4For VTE prophylaxis, match the agent and the duration to the setting, whether surgical, medical, or pregnancy.
5Watch for the drug-induced cytopenias and the interactions that reduce iron absorption.

Practice questions

Tap an answer to see why each option is right or wrong.

Question 1Common Anemias

What is the recommended ferric maltol regimen for iron-deficiency anemia?

Incorrect · Answer: D

PEBC Yield: Highdrug-selectiondose-adjustmentcounsellingpatient-education

60 mg elemental TID corresponds more closely to ferrous sulfate dosing (300 mg salt × 3 daily). Ferric maltol is not administered as 60 mg three times daily.

150 mg PO daily describes polysaccharide-iron complex (FeraMAX 150 mg), not ferric maltol. Different agent, different dose.

300 mg PO daily with vitamin C describes the older ferrous-salt approach. Ferric maltol is dosed by elemental iron content (30 mg/cap), not the older 300 mg salt-tablet figure.

D) (Correct)

Correct. Ferric maltol (Accrufer) is 30 mg elemental iron PO BID on an empty stomach. The maltol-iron complex is engineered for absorption in the small intestine and is given fasted. Key point: ferric maltol's empty-stomach BID dosing distinguishes it from polysaccharide-iron complex (150 mg daily) and the older ferrous salts (105-200 mg elemental daily, often divided).

Question 2Common Anemias

After starting folic acid, when do serum folate levels start to rise?

Incorrect · Answer: A

PEBC Yield: Highmonitoringpatient-educationscreeningdrug-selection

A) (Correct)

Correct. Serum folate begins to rise after more than 2 weeks of supplementation — the typical lab finding is that levels are not informative for at least that window. RBC folate (a more reliable measure of tissue status) is even slower to shift. Key point: do not recheck serum folate too early — the value will look unchanged not because folate is failing but because the lab is slow to track therapy.

Within 24 hours is the timing of the reticulocyte response, not the serum folate rise. The two endpoints are commonly conflated.

Three to four days matches the reticulocyte peak after starting B12 or folate, not the serum folate rise. Different lab, different timing.

Six months matches the neurologic-recovery timeline in B12 deficiency, not folate level rise. Wrong endpoint and wrong context.

Question 3Common Anemias

Which adverse effect is most important to monitor after starting an ESA?

Incorrect · Answer: C

PEBC Yield: Highadr-recognitionmonitoringsafety-referraldose-adjustment

Tempting because this is linked to liquid oral iron. It is wrong here because ESA safety monitoring is cardiovascular and thrombotic, not oral iron counselling. Would be correct if the question asked about oral iron counselling.

Tempting because this is an IDA symptom. It is wrong here because ESA safety monitoring is cardiovascular and thrombotic, not oral iron counselling. Would be correct if the question asked about disease presentation.

C) (Correct)

Correct -- hypertension and thrombotic events are important ESA safety concerns.

Tempting because this can occur with nutritional deficiency. It is wrong here because ESA safety monitoring is cardiovascular and thrombotic, not oral iron counselling. Would be correct if the question asked about folate or IDA signs.

Question 4Common Anemias

High CRP, low serum iron, low TIBC, and normal-high ferritin best fit which pattern?

Incorrect · Answer: B

PEBC Yield: Highdiagnosis-classificationmonitoringscreeningpathophysiology

Tempting because low serum iron overlaps. It is wrong here because inflammatory ferritin elevation can hide functional iron restriction. Would be correct if ferritin were low and TIBC high.

B) (Correct)

Correct -- inflammation raises ferritin and lowers available iron and TIBC, producing the anemia of chronic disease pattern.

Tempting because it can be microcytic. It is wrong here because inflammatory ferritin elevation can hide functional iron restriction. Would be correct if iron studies were normal with a compatible family or ancestry pattern.

Tempting because chronic illness can coexist. It is wrong here because inflammatory ferritin elevation can hide functional iron restriction. Would be correct if MCV were high with low folate.

Question 5Common Anemias

A normal RDW in microcytic anemia makes which diagnosis more plausible than IDA?

Incorrect · Answer: A

PEBC Yield: Highdiagnosis-classificationmonitoringscreeningpathophysiology

A) (Correct)

Correct -- thalassemia can present with microcytosis and a relatively normal RDW, unlike many IDA presentations.

Tempting because IDA is a common microcytic anemia. It is wrong here because normal RDW with microcytosis should broaden beyond IDA. Would be correct if RDW were elevated with low ferritin.

Tempting because it can affect RDW. It is wrong here because normal RDW with microcytosis should broaden beyond IDA. Would be correct if MCV were high with low folate.

Tempting because it can raise RDW. It is wrong here because normal RDW with microcytosis should broaden beyond IDA. Would be correct if Coombs testing and hemolysis features were present.

Question 6Common Anemias

PG is a 51 year old female with rheumatoid arthritis treated with methotrexate 15 mg po weekly and folic acid 1 mg po daily. She presents with a hemoglobin of 104 g/L, MCV of 108 fL, serum B12 of 310 pmol/L (normal 133-675 pmol/L), and RBC folate of 450 nmol/L (normal >305 nmol/L). Which of the following is the most likely cause of her macrocytic anemia?

Incorrect · Answer: B

PEBC Yield: Highadr-recognitiondiagnosis-classification

Anemia of chronic disease from RA is usually normocytic with a low-normal MCV and shows inflammatory markers in keeping with active disease. PG's MCV is 108 (frankly macrocytic) — that pattern points away from ACD and toward megaloblastic anemia.

B) (Correct)

Correct. Methotrexate is a folate antagonist (dihydrofolate reductase inhibitor). Even with folic acid 1 mg daily (~7 mg/week), some patients still develop megaloblastic features because methotrexate's marrow effects can outpace the supplementation dose. CPS recommends at least 5 mg folic acid per week with chronic methotrexate, and patients with breakthrough macrocytosis sometimes need higher doses. Key point: a macrocytic anemia in a methotrexate patient with documented adequate B12 and RBC folate is most often the drug itself — confirm folate dose adequacy and consider escalation.

Pernicious anemia would show a clearly low B12 with antibody-mediated intrinsic factor deficiency; her B12 is 310 pmol/L (mid-range), which makes PA implausible.

Insufficient folic acid is plausible at the dose level (1 mg/day is borderline vs the 5 mg/week minimum), but her RBC folate is 450 nmol/L (above the 305 cutoff) — biochemically, she is folate-replete. The mechanism is direct methotrexate marrow effect, not folate deficit.

Question 7Common Anemias

Concave spoon-shaped nails in an anemic patient point most directly to which condition?

Incorrect · Answer: B

PEBC Yield: Highclinical-presentationdiagnosis-classificationscreeningpathophysiology

Tempting because it can coexist with inflammation. It is wrong here because koilonychia is a clinical clue for iron deficiency. Would be correct if the stem described inflammatory iron sequestration labs.

B) (Correct)

Correct -- koilonychia is an iron-deficiency-specific sign.

Tempting because it can cause fatigue and neurologic symptoms. It is wrong here because koilonychia is a clinical clue for iron deficiency. Would be correct if the stem described macrocytosis with B12 deficiency.

Tempting because it causes hemolytic anemia. It is wrong here because koilonychia is a clinical clue for iron deficiency. Would be correct if the stem described vaso-occlusion or sickled RBCs.

Question 8Common Anemias

Which antibiotic class should be separated from oral iron to avoid chelation?

Incorrect · Answer: D

PEBC Yield: Highdrug-interactioncounsellingdispensingpatient-education

Tempting because some have interactions. It is wrong here because iron chelation can cause treatment failure with certain antibiotics. Would be correct if the question asked about a non-chelating interaction concern.

Tempting because they are common antibiotics. It is wrong here because iron chelation can cause treatment failure with certain antibiotics. Would be correct if the question asked about a class not chelated by iron.

Tempting because it treats UTI. It is wrong here because iron chelation can cause treatment failure with certain antibiotics. Would be correct if the question asked about a fluoroquinolone or tetracycline.

D) (Correct)

Correct -- iron chelates fluoroquinolones and can reduce antibiotic absorption.

Question 9Common Anemias

Which medication does NOT usually need separation from oral iron?

Incorrect · Answer: B

PEBC Yield: Highdrug-interactioncounsellingdispensingpatient-education

Tempting because fluoroquinolone chelation is important. It is wrong here because not every common medication interacts with iron. Would be correct if the question asked for a drug that must be separated.

B) (Correct)

Correct -- acetaminophen does not have the key chelation or absorption interaction seen with iron.

Tempting because iron reduces levothyroxine absorption. It is wrong here because not every common medication interacts with iron. Would be correct if the question asked for a drug that must be separated.

Tempting because calcium reduces iron absorption. It is wrong here because not every common medication interacts with iron. Would be correct if the question asked for a supplement that must be separated.

Question 10VTE Prophylaxis

A 33-year-old woman who is 14 weeks pregnant has a history of one prior unprovoked DVT 4 years ago. Her current weight is 72 kg. The obstetrician has decided antepartum prophylactic anticoagulation is indicated. The patient asks the pharmacist for confirmation of the regimen. Which regimen best matches Thrombosis Canada antepartum thromboprophylaxis guidance for this patient?

Incorrect · Answer: A

PEBC Yield: HIGHpregnancylmwhenoxaparinthromboprophylaxisweight-based-dosing

A) (Correct)

Correct. The standard antepartum thromboprophylaxis regimen for a patient with one prior unprovoked VTE is enoxaparin 40 mg SC daily continued through pregnancy and for at least 6 weeks postpartum (minimum total duration 3 months). LMWH is preferred because it does not cross the placenta and has no documented teratogenic effects. Key point: pregnancy + prior unprovoked VTE = LMWH prophylactic dose through pregnancy plus 6 weeks postpartum.

Warfarin is teratogenic (warfarin embryopathy from first-trimester exposure, fetal bleeding later) and is avoided throughout pregnancy except in specific mechanical-valve indications with specialist input.

Apixaban (and other DOACs) is avoided in pregnancy due to insufficient safety data and confirmed placental transfer. Not a recommended option.

ASA 81 mg daily is insufficient as VTE prophylaxis in pregnancy after a prior unprovoked VTE — antiplatelet monotherapy does not prevent venous thrombosis at this risk level. May have a role in preeclampsia prevention but not for VTE.

Want the full bank?

These are a sample. The full bank adds full-length cases and timed mock exams.

Sample full case

One patient with several linked questions, the format the real exam uses for case clusters.

PH is a 32-year-old female who reports fatigue, weakness, and shortness of breath on exertion over the past 2 months. She has a levonorgestrel intrauterine system and reports only light monthly spotting. PMH: celiac disease with inconsistent gluten-free diet adherence, previous iron deficiency, vitamin D deficiency. Current medications: levonorgestrel IUS, vitamin D3 1000 IU daily, calcium carbonate 500 mg BID, multivitamin daily. She does not take anticoagulants or NSAIDs regularly and denies melena, hematochezia, or pregnancy.

Laboratory Results:

Parameter	Value
Hb	98 g/L
MCV	72 fL
Ferritin	8 ug/L
TIBC	78 umol/L
Serum iron	5 umol/L
RDW	17.2%
Reticulocyte count	0.8%

Question 1Common Anemias

Which anemia pattern best matches PH's laboratory results?

Incorrect · Answer: A

PEBC Yield: Highpebc-recall-remixiron-deficiency-anemiamicrocytic-anemiaceliac-diseaseius-levonorgestrelanemia-classificationmcv-interpretation

A) (Correct)

Correct - low hemoglobin, low MCV, low ferritin, low serum iron, high TIBC, and high RDW fit iron deficiency anemia.

Folate deficiency usually causes macrocytosis rather than the low MCV seen here.

Hemolysis would be suggested by features such as elevated reticulocytes, bilirubin, or LDH; the reticulocyte response here is not increased.

Anemia of chronic disease is often normocytic or mildly microcytic with low/normal TIBC and normal/high ferritin, not this iron-deficiency pattern.

Question 2Common Anemias

Which history feature is the most likely contributor to PH's recurrent iron deficiency?

Incorrect · Answer: C

PEBC Yield: Highpebc-recall-remixceliac-diseaseiron-malabsorptionida-etiologylevonorgestrel-ius-reduces-bleedingdifferential-diagnosis

Calcium can reduce iron absorption if taken together, but it does not directly suppress bone marrow and is not the best explanation for recurrent iron deficiency in this case.

A levonorgestrel IUS usually reduces menstrual bleeding. PH reports only light spotting, so this is not the most likely driver.

C) (Correct)

Correct - celiac disease can impair iron absorption, especially with inconsistent gluten-free diet adherence. This fits recurrent iron deficiency without heavy bleeding.

Vitamin D deficiency does not directly cause iron deficiency anemia.

Question 3Common Anemias

PH has no drug insurance and asks for a low-cost oral iron option. Which product is the best recommendation from the options listed?

Incorrect · Answer: C

PEBC Yield: Highpebc-recall-remixoral-iron-therapyferrous-sulfatecost-effectivenessiron-supplement-selectionelemental-iron-content

Ferrous gluconate is an oral option and may be better tolerated for some patients, but it is not usually the lowest-cost default option from this list.

Ferrous fumarate is an oral option with higher elemental iron per tablet, but cost and tolerability vary. It is not the best low-cost default here.

C) (Correct)

Correct - ferrous sulfate is a common low-cost first oral iron choice. Counselling should cover GI adverse effects, separation from calcium when possible, and adherence.

Iron dextran injection is not a low-cost first choice and is reserved for situations such as intolerance, nonresponse, malabsorption with need for IV therapy, or urgency.

Question 4Common Anemias

PH starts oral iron and her hemoglobin later normalizes. What duration of therapy is most appropriate to replenish iron stores?

Incorrect · Answer: C

PEBC Yield: Highpebc-recall-remixiron-therapy-durationiron-store-replenishmentferritin-targettreatment-monitoringida-management

A full year after hemoglobin normalization is not routinely required if iron stores recover and the cause is addressed.

Stopping as soon as hemoglobin normalizes risks leaving iron stores depleted.

C) (Correct)

Correct - oral iron is commonly continued for about 3 months after hemoglobin normalizes to replenish iron stores, with follow-up ferritin/iron indices as appropriate.

Indefinite therapy is not automatic. If celiac disease remains poorly controlled or iron deficiency recurs, longer treatment or further workup may be needed.

Full-length cases like this, across every PEBC domain, live in the question bank.

Frequently asked questions

Is hematology high yield on the PEBC exam?: Yes, especially the anemias, which are common and very counselling-focused for a pharmacist. VTE prophylaxis and the drugs that affect blood counts also come up. The exact mix is randomized from one sitting to the next, but hematology is consistently worth solid preparation.
What hematology topics should I focus on for the PEBC?: Focus on classifying and working up anemia by cell size, iron-deficiency anemia and oral iron counselling, B12 and folate deficiency, and VTE prophylaxis. Knowing the iron counselling and when to investigate the cause is especially high yield.
Which references should I use for hematology on the PEBC?: Use standard hematology references for the anemias, and Thrombosis Canada for venous thromboembolism prophylaxis and anticoagulation. The PEBC expects the Canadian approach to prophylaxis and the practical counselling for oral iron.
How should I study hematology for the PEBC?: Get comfortable classifying anemia by cell size, learn the oral iron counselling cold, and know the VTE prophylaxis basics.